Senate anti-addiction plan seeks to ease access to treatment

Thursday

May 8, 2014 at 5:05 PMMay 9, 2014 at 2:05 AM

By Colleen QuinnState House News Service

BOSTON -- Pharmacists would substitute abuse-deterrent drugs for non-abuse deterrent formulas, physicians would need to receive training on the state’s prescription monitoring program before renewing their license, and insurance carriers would face coverage requirements for drug and alcohol treatment under a new Senate plan aimed at curbing drug addiction problems in Massachusetts.

The plan calls for a new certification process for drug and alcohol treatment centers, with insurers banned from requiring prior authorization for anyone seeking services from a certified center.

It removes prior authorization for acute treatment services for all commercial insurance carriers and requires coverage up to 21 days. It also removes prior authorization for acute treatment services for all MassHealth Managed Care entities, and requires coverage up to 15 days of clinical services.

Insurance carriers would be required to provide reimbursement for substance abuse treatment services delivered by a licensed alcohol and drug counselor.

“This is a bold move, and we know it,” Senate President Therese Murray said about the overall plan, which was released Thursday morning with an announcement that a Senate vote is planned for Tuesday.

“We have to break the cycle of addiction before it breaks us, and the time to act is now,” Murray added.

Senators said both illegal and legal prescription drugs have contributed to overdose deaths in the state.

Eric Linzer, a spokesman for the Massachusetts Association of Health Plans, said the association hasn’t had a chance to fully review the bill, and are trying to get an understanding of its impact. He added that health plans in the state already cover a wide range of substance abuse treatment.

“We follow nationally recognized evidence-based clinical criteria, including the American Society of Addiction Medicine,” Linzer said. “Any approaches need to focus on interventions that have been proven to work, ultimately.”

Murray said health care officials and policymakers need to stop talking about treatment services separately. “Each level of care is related to the next,” she said, adding addiction is a chronic disease.

The new average age of addicts in Massachusetts is 15 to 25 years old, Murray said.

Sen. Stephen Brewer (D-Barre) said costs associated with the proposals will be rolled out in the Senate’s version of the fiscal year 2015 budget, expected to be unveiled next week.

Murray said the bill will also deal with mental health parity and the need for more mental health beds.

“We will have a budget that comes out next week that will reflect our interest in opening more community-based beds as well as opening more beds in the new institution that we have in Worcester,” Murray said. “So we will be putting our money, your money, where it should be.”

The plan is the culmination of work of a special Senate committee created in January to look at the opiate epidemic in the state and evaluate the drug treatment process and detox programs in the wake of an uptick of the number of people civilly committed by the courts for drug addiction.

“In each and every one of those hearings that we held across the state there were families that would come up to us after who had a loved one who couldn’t get into detox because they didn’t have enough drugs in their system, or they weren’t high enough,” she said. “We had loved ones who had no place to go once they were done their detox, thus falling back to the same communities from which they came from and starting the process over again.”

Under the plan, a commission will create lists of drugs that are abuse deterrent that are similar to non-abuse deterrent ones.

The mandatory substitution of abuse-deterrent drugs will not only address Zohydro ER - which Gov. Deval Patrick attempted to ban because it is an opiate that is not tamper-proof - but other drugs that fall into the same category, Sen. John Keenan (D-Quincy) said. Insurance carriers will be required to cover the substitute drug like any other.

“When a physician writes a prescription and that prescription goes to a pharmacy, the pharmacist will have the ability to substitute the abuse-deterrent drug off the formulary for the non-abuse deterrent drug,” Keenan said. “So when you have a very dangerous non-abuse deterrent drug that is prescribed we will now have a way for a pharmacist to substitute that so a patient is getting a drug that is less capable of being crushed, melted, whatever the case may be, and less capable of being abused.”

Murray stressed the proposal is not aimed at hurting those who use opiates for chronic pain, a concern that lawmakers heard during the last hearing on the topic at the State House Tuesday.

“I want to assure the people of Massachusetts that we are not here to stop those who have chronic pain or are in need of end-of-life care from getting the drugs and the treatment they need to lead comfortable and productive lives,” she said. “It is our goal that this legislation walks the careful line to preventing abuse without blocking access to those who really need it.”

Local and state health officials will also work together to closely monitor synthetic drugs cropping up on store shelves, Keenan said.

The focus around drug addiction tends to be on opiates, Keenan said, but synthetic drugs are part of the problem. Under the Senate plan, if local health officials and law enforcement become aware of synthetic drugs creating problems, they will report the information to the state commissioner of public health. The commissioner will have the authority to put the substance on an emergency schedule, pulling it from store shelves immediately, Keenan said.

- Requires the Department of Public Health to list locations of prescription drug drop boxes on its website and submit a list of counties without prescription drug drop boxes to the Legislature.

- Directs the Center for Health Information and Analysis to review the accessibility of substance abuse treatment and the adequacy of private insurance coverage. It tasks the Health Policy Commission with recommending policies to ensure access and coverage for substance abuse treatment.

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